Cluster Headache Flashcards
What is a cluster headache?
Recurrent, severe headaches on 1 side of the head typically around the eye, tending to recur over a period of several weeks typically once per year
What is the aetiology of cluster headaches?
UNKNOWN aetiology
List 6 triggers/ associations/ risk factors of cluster headaches
SMOKING
ALCOHOL
Head trauma
Sleep disruption
Solvents
FH
Describe the epidemiology of cluster headaches
M > F (4:1)
Peak: 20-40y
What are the 2 types of cluster headache?
Episodic: attacks occur in periods of 1w- 1y, separated by pain-free period lasting at least 3 months
Chronic: >1y without remission/ short remission <3 months
Describe the pain experienced in cluster headaches
Rapid onset ~10 mins
Intense, sharp + penetrating
Centred around the eye, temple or forehead
Unilateral
Lasts 15 mins - 3h untreated
Occurs once every other day - 8x per day
List 6 associated ipsilateral symptoms of cluster headaches
Conjunctival injection +/or Lacrimation
Nasal congestion +/or Rhinorrhoea
Forehead + facial sweating
Forehead + facial flushing
Sensation of fullness in the ear
Miosis +/or ptosis
Describe behaviour during cluster headaches
A sense of restlessness or agitation (typically walk up + down; rock to + fro; clutch the affected side).
What investigations should be performed for cluster headaches?
CLINICAL dx based on hx
Neuro examination
Seek specialist advice
Most have imaging to r/o underlying brain lesionss
What is the investigation of choice for cluster headaches?
MRI with Gadolinium contrast
What are the 3 cardinal features of cluster headaches?
Trigeminal distribution of the pain
Ipsilateral cranial autonomic symptoms
Circadian/ circannual pattern of attacks.
Describe acute management of cluster headaches
Subcutaneous Triptan: Sumatriptan
+/ or
Oxygen 12-15L via non-rebreathe for 15-20 mins
Describe prophylaxis of cluster headaches
Verapamil
